Provider Demographics
NPI:1396861100
Name:KNECHT AUDIOLOGY INC
Entity Type:Organization
Organization Name:KNECHT AUDIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KNECHT LOY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:765-474-4544
Mailing Address - Street 1:2606 VETERANS MEMORIAL PKWY S
Mailing Address - Street 2:STE. 1
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-9192
Mailing Address - Country:US
Mailing Address - Phone:765-474-4544
Mailing Address - Fax:765-474-1122
Practice Address - Street 1:2606 VETERANS MEMORIAL PKWY S
Practice Address - Street 2:STE. 1
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-9192
Practice Address - Country:US
Practice Address - Phone:765-474-4544
Practice Address - Fax:765-474-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001969A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000370115OtherANTHEM PIN NUMBER
IN1902828031OtherTYPE 1 NPI NUMBER